FROM THE TPP TO THE ACA: Silence invaded the (corporate news) suburbs!

FRIDAY, JULY 17, 2015

Part 5—The things our own favorites won’t say: We modern liberals are the brainiest, most enlightened life-forms found anywhere on the earth.

That fact is widely understood. Proceed to any “liberal” site. You’ll find a string of brainy, enlightened people stating and implying that fact.

When they do so, they make us liberals feel good. They’re telling us that we’re the best!

In fairness, this behavior can produce the occasional tiny small paradox. Last week, for example, we noted the way our corporate-paid intellectual leaders treated the Trans-Pacific Partnership in recent months.

How odd! On our own cable news channel, they treated congressional victories by the TPP as part of Obama’s “best week ever,” even though the TPP is widely opposed by liberals and progressives. And not only that:

In early May, Rachel warned us, on one occasion, that the TPP might “kill huge swaths of working-class jobs.” But how odd! She never mentioned this potential problem again. Instead, she clowned in clownishly tribal ways on the selective occasions when she mentioned the proposal at all.

A skeptical person might imagine that these corporate-paid multimillionaires are insincere in some tiny small barely perceptible way. A skeptic might have similar thoughts as he watches the way these grabbers and climbers have covered the ACA down through the years and in the past few weeks.

It isn’t Barack Obama’s fault that our American health care remains the sick joke of the developed world. But that’s the continuing state of play, a fact you won’t hear from “The Puppy,” Chris Hayes, as he boasts about the fact that only 21 percent of low-income adults lack health insurance.

Seventy years after President Truman, it’s a bit of a tiny small paradox! We’re the brainiest people on earth—but we’ve never been able to institute full-blown national health care of the type the other nations have!

On your liberal cable channel, you won’t see this problem discussed. They’ll tell you about the Confederate flag, keeping you happy with that. Night after night, your increasingly bizarre Darling Rachel will tell you, in the dumbest possible ways, what Fox News is going to do with the first Republican debate.

She doesn’t tell you that CNN is basically doing the same darn thing with the second Republican debate. Nor does she discuss the fact that the RNC has signed on to these plans, which aren’t as crazy or as heinous as she says, night after night after night.

There’s something else she doesn’t do. She doesn’t discuss the ACA, any more than she discusses the TPP. A cynic would think that Our Own Corporate Multimillionaire doesn’t care about the people who have been left behind despite our self-admitted brilliance, even after seventy years.

As Rachel clowns and bangs on her toys, she isn’t going to waste your time with high deductibles and the effect they have on that woman in Illinois. Nor is she going to waste your time with the high cost of prescription drugs and the problem they present to that woman in Arkansas.

Like a long string of overpaid “liberals” before her, Our Darling Rachel shows few signs of caring about such underclass droogs. Let’s close the week with a quick review the most significant matter you won’t hear discussed on her increasingly ludicrous program, where the joy of the toy xylophone is turning liberal brains to profit-producing mush.

(Profit-producing? Your darling’s ratings seem to be up since she headed down this disgraceful, embarrassing path.)

Why is that woman in Illinois faced with that high deductible? Why is that woman in Arkansas being slammed by those high drug prices?

Your darling Rachel, who has superb health care herself, won’t waste your time on such questions. But Brother Krugman drank from that well back in 2005.

He did a series of columns that spring about our gruesome American health care. In the passage shown below, he touched on the dirtiest secret of all.

Krugman broke every rule in the book this day. He discussed how crazily bad our health system is compared to other developed nations.

KRUGMAN (4/15/05): Britain isn't the country we want to look at, because its health care system is run on the cheap, with total spending per person only 40 percent as high as ours.

The countries that have something to teach us are the nations that don't pinch pennies to the same extent—like France, Germany or Canada—but still spend far less than we do...

Let me rattle off some numbers.

In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending.

Amazing, isn't it? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else.

What do we get for all that money? Not much.

Say what? On a per person basis, Great Britain was spending forty percent as much as we were on health care? France was spending a shade more than half, while getting better outcomes?

“Amazing, isn’t it?” Krugman asked. It is amazing! And you will never see this matter discussed on The One True Channel.

In his column in 2005, Krugman cited spending figures from 2002. According to the OECD, these are the figures which obtained ten years later:

In the case of a smaller Euro-state, miraculous Finland spent $3403 per person on health care that year.

In our mainstream press corps, we’re constantly told that we should copy glorious Finland in our public schools. We’re never told that the miraculous nation is somehow able to provide universal health care for 40.3% of our own per capita outlay. Or that the more profligate France ran its renowned health care system at 47.7% of our per capita outlay that year.

As we’ve noted in the past, the data posted above are the most striking data of which we’re aware. They’re never discussed on our corporate news channel by our own corporate hosts.

A cynic would think that he could explain that puzzling state of affairs.

Why is that woman in Illinois paying that large deducible, even after receiving assistance through the ACA? Why is that social worker in Arkansas unable to pay for her prescription drugs?

The answers are lurking inside those bloated spending numbers, which reflect large sums being siphoned away by a range of corporate interests. For whatever reason, Maddow and Hayes never quite get around to talking about this massive scam, which is executed against red and blue voters together.

Let’s compare the United States to France that year. On some undiscussed, undisclosed basis, $4409 was walking away in the course of our bloated health care spending—$4409 per person!

$4409 per person! That’s missing money which helps explain our famous stagnant wages, which may not seem like such a big deal at the corporate cable pay level. Or we can think about that missing money another way. As Dean Baker endlessly notes, our federal deficits disappear if the cost of health care in the U.S. is reduced to the level of spending in France.

Those deficits have driven our discourse for decades. They’re hiding right there in plain sight!

Will the proposed TPP kill “huge swaths of working-class jobs?”

People, we can’t answer that. We watch MSNBC!

Where does all the missing money in our health care system go? We can’t answer that question either! We’re too busy watching Rachel bang on her toy xylophone!

We liberals are sure we’re the brightest and best. Has there ever been a tribe which was so easily played?

This just in from Sanders voters: “Medicare for all” would solve this whole mess!

Liberals, please! You can run a single-payer system with grossly bloated spending. Medicare’s failure to negotiate prescription drug prices is one of the few parts of this scam which occasionally does get discussed.

Ask yourself this: Have you ever seen data comparing per person health spending on Americans over 65 to comparable spending in other developed nations?

Liberals, please! Rachel is banging away on her toy! Buzzkills like that aren’t allowed!

86 comments:

Krugman says: "What do we get for all that money? Not much." I disagree. We are a supposedly free-market capitalist economy with limited government regulation (especially compared to the European countries on that list). We get to maintain that type of economy in return for our bloating spending on health care (and everything else we spend money on). Our bloated spending pays for jobs in which people provide the record-keeping and billing, advertising, administration, and extra middleman accounting for health care provided by a myriad of different types of professionals, most working independently and requiring a great deal of coordination (more jobs). We also get lower taxes in exchange for paying for the bulk of our needs out of pocket, either through premiums or co-pays and deductibles. People in those European countries pay for their health care through their taxes and the figures Somerby quotes don't show whether the taxes paid equal the services received per capita. People in Europe like it that way, but people in the USA don't seem to want to pay for their services via taxes -- they want to pay out of pocket, and some don't want to pay at all. In exchange for our economic and personal freedom, we tolerate economic unfairness and a 1% that skims a huge profit off the top in exchange for owning and running the businesses involved. This too occurs in all segments of our economy, not just health care. It is the price we pay for being capitalist and relatively unregulated.

Changing this in a major way would mean changing the way our economy and government work together (or don't) and radically revising our economy to become a socialist democracy, like those in Europe, instead of a capitalist one. Conservatives think that would kill our entrepreneurial spirit and leave less opportunity for development of new enterprises. I don't know whether that is true or not, but if it is, that is something we are currently getting that Europe is not -- innovation and new services or products. Some claim our innovation actually comes from our research universities. If that's true, then we are systematically underfunding them (starving them under conservative austerity) and I do not expect that innovation to continue -- se we may not receive that benefit in the future unless drug companies pick up the slack. They claim that is one of the benefits we get from being bilked on prescription drug prices. Allowing Medicare to negotiate would thus weaken drug company ability to produce new drugs (according to them). So, we would have to nationalize research and invest in it much more than we are currently doing, if we change how drugs are marketed. (Broken into 2 parts due to character limitations)

These are important problems that should be discussed. I don't see us becoming the type of government and economy that would support European-style health care delivery, no matter how frustrated we get with our current services. Europe was able to do that because their liberal parties took power after WWII (because the conservatives were allied with fascist and Nazi governments) and had carte blanche to change things radically. Some of those European countries didn't exist before WWII, so they could start fresh. In contrast, the US was formed explicitly to be different than Europe. It didn't go through the changes in political leadership after WWII that occurred in Europe, didn't have the health crisis of malnutrition and disease that occurred post-war in Europe to cope with, so it had no incentive to change when Europe did. One thing seems clear -- we cannot expect to get the benefits of European style nationalized health care by revising only the health care system (e.g., expanding Medicare) because the health care system is embedded in our larger economy. It supports jobs and businesses whose collapse would cause major upheaval (recession or depression). So we have to ask what kind of limited or incremental changes would improve things best. Seems to me that is already being done by our presidential candidates. It would be nice if Rachel and others covered what they are proposing.

This kind of mindset will prevail in this country as long as nobody with a conspicuous platform explains it's not an entrepreneurial spirit, the free market, and custom which has us trapped in such a cruel and wasteful health care system. Instead, we are where we are because of the art of circumlocution.

1) To the extent patent protections are at the root of some of the high costs in health care, the health care system does not operate as a free market.

2) As long as the cost of medical training, the number of student slots at accredited doctor factories, and the current visa policy is in place the health care system is not a free market. For going on a century the supply of doctors has been kept low in this country by forces hostile to market competition for medical professionals.

(Factor in, also, the non-free market reality that medical specialists collude to set the de facto floor for their fees and medical services when they are empowered by Medicare to come up with Medicare's payment scheduled.)

3) As long as life and death or just pain or physical dysfunction is involved in with health care issues, health care is not a free market good- there's an aspect of coercion driving all of the decisions the consumer makes.

(Factor in also, it's almost impossible for a cash out of pocket purchaser of hospital services to get a fee schedule from hospitals before services are rendered which leads to the habit of hospitals to gouge patients who don't have private insurance or the government paying part of a pre-negotiated price.)

4) As long as nobody explains that private health care insurance uselessly adds 10-15%* to the cost of what breaks down to 7% plus percent of the entire economy, and that doesn't factor in the time wasted by consumers in selecting and dealing with these vendors, the public won't understand you could send everyone working for less than $100,000 a year in the private medical insurance industry with full pay from the government for five years and the economy would be no worse off in total health care costs or in total health care delivered- and in the meantime those workers could be off finding something useful to do as their next career.

*That 10-15% mark up is what existed prior to ObamaCare, and I'm going to predict that's what's going to prevail after a few years under the new regime though I've not seen a discussion of the these numbers recently.

The supply of doctors is only partially limited by medical schools and the AMA (which sets licensing requirements). It is limited also by the disdain students show for the hard work involved in studying the sciences. There are many medical jobs going unfilled because there are insufficient qualified individuals applying for them. Medical specialists can thus set their own pay because, working for themselves, they are the only ones available to do that work. With the defunding of universities and the lack of financial support for students, this problem is exacerbated. In private practice, it isn't medicare or hospitals that set prices for procedures, it is physicians too who decide what is worth to them to do the work. It is hard to find a specialist-qualified physician who is not overworked in order to meet the needs of patients. Could more people do the work? Yes, but only if they first go through the training, and that is the bottleneck. Personally, I do not want anyone who cannot qualify for med school (as it stands) to become my doctor.

CMike is wrong about the markup on hospital services. When a patient does not have insurance, they get charged much less than an insurance company or the government. If they are billed more, it is with the expectation that they will not be paying the bill and their default will be written off against the taxes and expenses of the hospital (or doctor's office). If someone does not understand this, it is because they have not discussed it with the people they owe the money to. People walk away from medical bills routinely. It is inefficient and unfair (when people do actually pay those bills) and much less than honest, but that is how it works. So much of the "missing" money on the books is there as numbers but not real in the sense that it comes from anyone's pocket. This kinds of thing happens in other forms of business too, and especially on Wall Street.

I don't believe we have free markets in a wide variety of segments of our economy, for one reason or another. It is a criticism of our economy from the right and the left both. Many other consumer necessities are imposed by coercion. Try finding and holding a job without a car. Try having a comfortable life without admission to college these days. These things are just as coercive as health care -- much of which is about cosmetics, pain management and quality of life, not life or death. Physicians today believe that many of people's health problems could be prevented by attention to diet, exercise, stress management, sufficient sleep and similar lifestyle changes which people ignore. When they do see a physician, people do not follow their instructions and they do not comply with medication or treatment plans. So people are not necessarily being coerced by life or death survival, but are visiting doctors to help them maintain unsustainable lifestyle choices (especially smoking and alcohol or drug abuse). If Americans didn't insist on their freedom to abuse drugs, for example, health care costs could be greatly reduced, since alcoholism, drug abuse and drug-related violence account for much of the traffic in the emergency room and occupation of hospital beds. Similarly, our choice to avoid mandatory treatment of mental health problems (which is required in many European countries) results in repeated readmissions and neglect of co-occurring medical problems (comorbidity). So our attitude about personal freedom, very different than in Europe, has implications for our costs.

Americans usually cite the lack of ability to attend a chosen physician and wait times for non-urgent procedures as reasons to avoid managed health care. That suggests they are prioritizing their time over costs. To suggest that the time wasted in selecting providers adds to costs is true but Americans prefer to waste time that way instead of being assigned to providers or having to wait for non-urgent care until resources are available. So we have duplication and wasted facilities (working at less than full capacity) because Americans want everything to happen now (or at their personal convenience). Look at the furor when Obama's promise about keeping your doctor was occasionally not possible.You cannot get a fee schedule because people would balk at paying for not just that aspirin but all the associated buying and inventorying and warehousing costs associated with administering that aspirin -- things people don't think they should be paying for at all.

One night last summer at her home near Stamford, Conn., a 64-year-old former sales clerk whom I’ll call Janice S. felt chest pains. She was taken four miles by ambulance to the emergency room at Stamford Hospital, officially a nonprofit institution. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news.

The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm. Out of work for a year, Janice S. had no insurance. Among the hospital’s charges were three “TROPONIN I” tests for $199.50 each. According to a National Institutes of Health website, a troponin test “measures the levels of certain proteins in the blood” whose release from the heart is a strong indicator of a heart attack. Some labs like to have the test done at intervals, so the fact that Janice S. got three of them is not necessarily an issue.

The price is the problem. Stamford Hospital spokesman Scott Orstad told me that the $199.50 figure for the troponin test was taken from what he called the hospital’s chargemaster. The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital. Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document.

However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.

Because she was 64, not 65, Janice S. was not on Medicare. But seeing what Medicare would have paid Stamford Hospital for the troponin test if she had been a year older shines a bright light on the roll the chargemaster plays in our national medical crisis — and helps us understand the illegitimacy of that $199.50 charge. Here and elsewhere I define operating profit as the hospital’s excess of revenue over expenses, plus the amount it lists on its tax return for depreciation of assets—because depreciation is an accounting expense, not a cash expense.

John Gunn, chief operating officer of Memorial Sloan-Kettering Cancer Center, calls this the “fairest way” of judging a hospital’s financial performance the troponin test if she had been a year older shines a bright light on the role the chargemaster plays in our national medical crisis — and helps us understand the illegitimacy of that $199.50 charge....

It turns out that Medicare would have paid Stamford $13.94 for each troponin test rather than the $199.50 Janice S. was charged. Janice S. was also charged $157.61 for a CBC — the complete blood count that those of us who are ER aficionados remember George Clooney ordering several times a night. Medicare pays $11.02 for a CBC in Connecticut. Hospital finance people argue vehemently that Medicare doesn’t pay enough and that they lose as much as 10% on an average Medicare patient. But even if the Medicare price should be, say, 10% higher, it’s a long way from $11.02 plus 10% to $157.61....[END QUOTE]

[QUOTE] Why Aren't We Rushing to Import More Doctors and Why Isn't the NYT Asking?

Published: 28 November 2013

Roughly one third of all doctors are in the top one percent of the income distribution and the vast majority are in the top two percent. This likely explains both the reason as to why the government is not looking for ways to bring more doctors into the country and the reason the NYT is not raising the question in an article discussing a shortage of doctors willing to accept Medicaid reimbursement rates.

We have deliberately changed immigration rules and standards to make it easier for foreign computer engineers, nurses, and even teachers to enter the country and meet demand in these occupations. There is no economic reason why we would not do the same for doctors. The potential savings to consumers and the government and gains to economy would be several times larger for each qualified doctor that we brought into the country than for every nurse or teacher.

If the government were not actively engaged in efforts to redistribute income upward, regularizing a flow of doctors, with foreign students trained to U.S. standards, would be a major focus of trade agreements like the Trans-Pacific Partnership. (We could design a mechanism to ensure that earnings of foreign doctors are taxed and repatriated to home countries so that developing countries could train 2-3 doctors for every one that comes to the United States. Even an economist could figure out how to design such a mechanism.)

Anyhow, it is remarkable how trade is so selectively defined that enormous potential gains that would disadvantage the wealthy never even get mentioned. While the protectionist barriers that cause doctors in the U.S. to get twice the pay as doctors in other wealthy countries never get mentioned, we get endless hysterics over a couple thousand dollars a year going to families receiving food stamps.... [END QUOTE]

Graduates of medical schools in other countries are admitted to internship and resident training in the US. They have to pass the same boards as anyone else.

Doctors in the US must recertify regularly, at their own expense. If they are in private practice they pay their own malpractice insurance, staff and equip an office. Costs to convert to computerized records were paid by physicians if in orivate practice. They also pay back several hundred thousand in student loans and earn no money until they are close to 30 (depending on specialty). They earn more because of these realities. Those working for an HMO or university make much less. In Europe, education is free, there are no overhead costs borne by the physicians and no insurance. Hours are reasonable and working conditions much different including job content (what doctors do). It is an apples & oranges comparison.

Graduates of medical schools in other countries are admitted to internship and resident training in the US....

In limited numbers.

[American physicians] also pay back several hundred thousand in student loans and earn no money until they are close to 30. (depending on specialty). They earn more because of these realities.

Right, exactly. Now you're getting it. It's set up so that becoming a medical specialist is for people from affluent families who can exercise options not available to most other members of their age cohort who, regardless of how capable they might be, won't or can't wait until they're thirty to start earning money after having taken on additional piles of student debt following their undergraduate matriculation. It's an attractive career path for those who can rely on some family resources along the way because once you get the credential you do get a return that comes from providing a service that is kept in short supply- by design.

Yes, but you cannot shorten it without leaving out training important to competence. The career path in medicine for people from less favored backgrounds (or those willing to take out large loans and defer family life for a decade) is into nursing, technician, pharmacy, and a variety of other jobs that don't require as much training. These jobs pay better than non-medical fields because they too require an ability to learn science and math. The main disqualifying factor is letting kids avoid math in the lower grades so that they reach high school with a math deficiency and then cannot get the science background needed to apply for medical support jobs. Even being a physical therapist or nurse requires quite a bit of science. I see this every year with students who love animals but cannot hack the science needed to train as a vet. It is the same with the various medical jobs. And, being a market economy, a shortage of qualified people leads to higher salaries which drive up costs across the board. In Europe and other developed countries, kids aren't allowed to avoid math because they dislike it or aren't good at it. Parents and teachers brush aside these excuses and require kids to work harder to master it. In the US, we accept that disliking math is a good reason not to learn it. I wish we would stop that. Ninety percent of jobs require math and the higher paying ones require more math and science.

Many Americans distrust doctors who are brown skinned, have foreign sounding names, or accents -- it is one of our charming national traits. They refuse to be treated by them. Medical providers are worried that if they hire too many people who will be rejected by patients, their business will suffer. I have heard this discussion during hiring meetings, despite it being illegal to consider. It isn't just the AMA limiting opportunities for foreign-trained doctors.

Consider putting some paragraph breaks in your text. I appreciate you engaging and I've gone to the trouble of pasting it Notebook where I create my own paragraph breaks so it's easy enough to read, if not swallow.

Other people, however, aren't going to bother reading what you wrote once they see how you've formatted it. After all, it's not like you're the renowned 11:19 AM.

There is plenty of blame to go around. People have the system they're willing to tolerate. Michael Moore did an excellent film on American health care problems and it led to no change whatsoever. I'm just saying that the type of health care system we have is intertwined with beliefs and attitudes in the US that are difficult to change. It is easy to just blame greed and say give us a national single payer system, but Somerby has been asking why we don't have such a system and why no one talks about it, and that is a different matter.

Just as medicare does not pay the entire amount, people without insurance and the means to pay actually pay a fraction of the billed amount. I'm not saying the bill doesn't show those amounts -- they have to or the hospital ir doctor's office can't write off the loss. The studies of health care costs need to account separately fir what people pay, not just what they are billed.

Sorry @8:51, I didn't notice you had responded to my 8:39 PM here before I deleted it and I moved it to the correct position in the thread.

Anyway, if you read through the article at the [LINK] you'll see that Steve Brill does discuss what people actually pay and if you've read some Elizabeth Warren from the early aughts you'll know that medical expenses end up being a frequent cause of bankruptcy and a ruined credit report with all the implications that has for job hunting. From the Brill article:

[QUOTE] After weeks of back-and-forth phone calls, for which [Katilin] Goencz [a professional negotiator] charged Janice S. $97 an hour, Stamford Hospital cut its bill in half. Most of the doctors did about the same, reducing Janice S.’s overall tab from $21,000 to about $11,000.

But the best the ambulance company would offer Goencz was to let Janice S. pay off its $995 ride in $25-a-month installments. “The ambulances never negotiate the amount,” says Goencz [END QUOTE]

Their facts are not incompatible with my knowledge. I didn't say people pay nothing. I said they don't pay full invoice amounts. You can go bankrupt on insurance or Medicare copays if you have little income.

An example, my daughter, after college, was without insurance for a period. She had a rash on her hand and (unwisely) went to an emergency room at a New York City hospital. She saw a doctor for one minute, who told er to get some type of ointment. The bill for the emergency room and the doctor was $1,300 and they expected her to pay - they did agree to knock a couple hundred off the bill, though

That is another example of the price we pay to live in a capitalist economy. We can't get good information from our reporters because their main focus is on ratings, which means appealing to the lowest common denominator, which means clowning around, I guess. NPR was supposed to fix that.

Liberal, please! Medicare’s failure to negotiate prescription drug prices is one of the few parts of this scam which occasionally does get discussed.

Ask yourself this: Have you ever seen data showing how much of Rachel's revenue comes from selling cock drugs to limp old guys? Have you ever wondered why her banging around on her toy isn't a buzzkill for that?

It's MSNBC's fault that ratings go up the dumber the programming? Maybe Bob could blame We the People now and again --- the people whose eyes glaze over and change the channel to reality TV when national healthcare and trade agreements are covered.

It is MSNBC's fault. Like many cable shows that define a niche audience and focus on meeting its needs, they could have defined their audience as those who want to hear real reporting and not those who want an alternative to Jon Stewart with more clowning. Political junkies would watch a channel that covered news well -- they do already. Instead, too many stations are chasing that 18-35 male demographic and the kids. So we get Rachel's cocktail recipes, Ronan Farrow (a failed experiment) and superficial coverage because that's what hipsters care about.

There is absolutely no value in getting anyone other than political junkies to watch. As Somerby has pointed out, even they get fooled by the lack of adequate clarifications in the lead paragraph of stories in the New York Times. Blue state readers, of course, see right through Krugman and probably have since he first started playing them for rubes in his campaign to become the liberal MVP.

I wrote off Rachel Maddow (except for not bad at all book, which I read because She was covering an important, seldom covered subject) back in her Air America Days. She's on at theY sometimes and I find her pretty much as Bob reports. Occasionally, he has exsagurated her shortcomings. Rachel Maddow has never, we should observe, tried to sell her audience a bill of goods more inane, ridiculous, unsupportable and willfully moronic that the bill of goods the Daily Howler has been trying to foist on what's left of his respectful audience this week, namely that liberals are to blame for not convincing the right to accept more progressive modes of health care. Ladies and Gentlemen, it just does not get any stupider than that. You will notice the lack of links in the opening of Bob's post, where he claims a blanket, easy to justify condemnation of the entire left. NOT A SINGLE LINK TO WHAT HE IS CLAIMING IS SO COMMONPLACE. Soon enough, of course, he's back to his old whipping girl and his strange, very strange obsession. Sad really. If you go back and read The Daily Howler's work in Clinton time, I think it's fair to say you will find an almost completely different writer. Almost exclusively, matters of fact are brought into play to support positions. Speculating on motives is resisted. Falsehoods are exposed. What a far, far cry that useful writer was from the slop we have been served up this week.

Annons, if you ever admit to yourselves that you are not capable of thinking up handles, silly person 1 and silly person 2 should do the trick. The entire premise of this series of posts has been that the Democrats since Truman have failed to convince the right of the wisdom of universal health coverage, so that they are responsible for that and also Maddow, Maddow, and also Maddow. Go back and read it again, you two or single idiot.(s) Bob, who was ready to throw Obama overboard for his bad debate night, simply can't handle that liberals are took a half a victory lap for a week in which their President displayed some formidable leadership. He's a bore and you are too.

It isn’t Barack Obama’s fault that our American health care remains the sick joke of the developed world.

True, in the sense that Obama didn't create the structure that makes American health care expensive. OTOH with a veto-proof majority, he could have made our system more efficient, e.g. by copying the British system.

Greg, I think TDH makes a valid point. I don't think democratic pols or the so-called liberal pundits or media make much, if any, effort to explain the case for change in the system, or that the US pays so much more per capita with inferior results. Instead you get discussion about the confederate flag, and the like. The case hasn't been made or much talked about. You shouldn't be so sensitive to criticism of liberals.

"Where does all the missing money in our health care system go? We can’t answer that question either! We’re too busy watching Rachel bang on her toy xylophone!"

In some of the few sane comments in this box, CMike refers several times to an article written by Steven Brill which was the cover story of Time Magazine, dated April 4, 2013.

Brill is no stranger in journalism. He is not young. Time magazine is not outside the mainstream media Somerby claims to muse about. The article has been expanded to a best selling book published this year.

Yet Bob Somerby, for all his concern about the lack of coverage of medical costs has mentioned Brill's work on the topic fewer times since he began this format in 2011 than he has mentioned Rachel Maddow banging on her toy in this single post. He has devoted more words to decry Maddow as a time waster than he has devoted to someone actually examining where they money in health care is going.

This is the entirety of the attention Bob Somerby paid to a massive article and now a book examining how health care costs are established and where the money might be going:

Mr. Somerby, respectfully you're not showing the whole picture. Medicine is very expensive for the US and I don't doubt that's because of the powerful drug lobby. But it's not just medicine that creates cost, it's bureaucracy in the insurance companies and hospitals. Single-payer won't by itself bring down drug costs, but should a democratic agency run its own insurance company for the whole country, there would be less spending going to insurance salesmen, market research, and high paid "managed care" experts.

I'd like to bring your attention to the New York Times, who strongly oppose single payer on the principle that the market is the most efficient method of managing health care. This being an obvious lie, they must explain away the costs we get today, and they look at medicine and high-tech startups as the magic fairy dust ready to heal us. They even go as far as to publish attacks on psychiatry, which is a scandal in and of itself considering the newspaper's repute.

Although the ACA increased coverage, it also bought into this line fairy tale about the wonders of the market, relying on high-tech networking which stalled the funding, and ended up bleeding agencies of funds and workers.

I'm on board criticizing drug companies. But let's keep the whole picture. Opposition to single payer is helping create the corrupt system we see today.

Opposition to single payer was funded by the corruption we have today.

"The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington."

Steven Brill Time April 4, 2013

"Where does all the missing money in our health care system go? We can’t answer that question either! We’re too busy watching Rachel bang on her toy xylophone!"

I am pointing out that in his mainstream musings Somerby should have called attention to Brill's article instead of lazily reprinting his OCED list every six months and then launching another repetitious attack on his favorite target.

If Somerby were writing about the status of health care in the USA, it would be appropriate for him to cite or link to Brill's article and many others. His purpose is to critique the way health care is being covered in the mainstream press, so he links and cites people like Maddow. Your problem is that you don't understand his purpose. He is not discussing health care -- he is asking why our mainstream press does not cover health care. The reference to the OCED list is to show that there is something the press is ignoring, something that deserves coverage. Go back and read the masthead of this blog, where it says: "musings on the mainstream "press corps" and the american discourse".

Brill's extensive article was published back in April of 2013. Do you remember his outrageous anecdotes being the center of discussion for days thereafter on any of the corporate owned cable or broadcasted infotainment shows? I don't. When was the last time you can remember Brill's article or the subject of its focus mentioned at all on one of those shows?

As it was rather long compared to most magazine articles directed at a mass audience what percentage of readers do you think got through more than twenty percent of it? Even Noam Chomsky will concede there's a lot of useful, hostile to the status quo information to be found here and there in the mainstream media, but it's what is repeated and reinforced which ends up informing the general public.

And that's the thing, consider the topics corporate infotainment references and discusses on a repeated basis. As far as ObamaCare went, it seems to me one of the most featured subjects and one Brill devoted too much time to in his book, were the problems of the HealthCare dot gov website launch, a matter that ended up taking on an overblown political importance that lingers to this day but, otherwise, had little to no effect on the actual delivery of any healthcare in this country.

More Clinton rules. Yesterday Huffington Post published an article in which they string together a bunch of quotes of Bill Clinton from the past several years in which he comments on past occurrences during his term in office. They call this his "Mea Culpa Marathan," implying that he is deliberately going around apologizing for things he considers "mistakes" during his terms in office as part of some sort of self-serving campaign. Some of the so-called apologies are actually explanations of how the Republican congress resulted in changes to law that he believes were counter-productive. They don't fit the category of apology since he did not advance that legislation. Others are laws reluctantly signed because his veto would be overridden.

The point is that by compiling and juxtaposing these statements into a single list and calling it his marathon, they imply that he is on some mission (probably to support Hillary), instead of a thoughtful person responding to journalist questions over a long period of time (years). Then it is given a "what is he up to" spin. Huffington Post hates the Clintons.

"Unlike a lot of politicians, Clinton has shown a willingness to own up to his mistakes. Earlier this week, he offered a mea culpa around sentencing at the NAACP convention.-------Addressing the NAACP convention on Wednesday, Clinton admitted that his tough crime laws led to swelling prison populations.-----------

In 2010, Clinton said his decision to exempt derivatives from regulation was shortsighted and that he should not have listened to his economic advisers who urged him to do it."I think if I had tried to regulate them, because the Republicans were the majority in the Congress, they would have stopped it. But I wish I should have been caught trying. I mean, that was a mistake I made."--------While speaking in Mexico in February, Clinton apologized for the U.S. war on drugs...

In 1996, Clinton signed the Defense of Marriage Act,....in 2013, Clinton admitted the law was a mistake and urged the court to rule against it.-------Clinton has said that one of his biggest regrets as president was not intervening in the 1994 Rwandan genocide....“The United States just blew it in Rwanda."---------As president, Clinton called for Haiti to eliminate tariffs on imported, subsidized U.S. rice, Clinton called the tariff decision “a devil’s bargain.”

“It was a mistake. It was a mistake that I was a party to. I am not pointing the finger at anybody. I did that,” ---------

HIV/AIDS experts have criticized Clinton for not doing enough to fight the global AIDS epidemic as it grew in the 1990s. Worse than what he didn't do was what his trade office did do: fought hard for trade policies that strengthened and extended pharmaceutical patents, driving up prices worldwide, making not just HIV medications unaffordable. "It was wrong," Clinton later said.

Nowhere does the article use the term ""Mea Culpa Marathan" so it must be in a trailer/teaser the commenter found somewhere. Just as she/he found it "implies" something.

The headline of the article on my mobile device said "Mea Culpa Marathon". Why do you think someone would bother rounding up all of Clinton's past retrospective statements and putting them into a single article if not to make some point? The headline sums up their spin, that he is going around apologizing for some purpose.

One of more of you trolls think that if something is not explicitly stated it doesn't exist. You think there is plausible deniability when conclusions are implied instead of directly stated. It doesn't work that way. Your brain injury doesn't mean these meanings that are clear to others don't exist. I am very sorry you have limited cognitive ability, but that doesn't change how others interpret meaning. You waste everyone's time here when you pretend others are seeing things, just because you cannot.

Maybe they are just trying to hang Bill Clinton's regrets like an anchor around Hillary's neck. Digby today is examining whether Hillary has learned from Bill's mistakes or whether she is proposing different policies as a matter of political expediency. Either way, this is a discussion that benefits Republicans.

"Digby today is examining whether Hillary has learned from Bill's mistakes or whether she is proposing different policies as a matter of political expediency. Either way, this is a discussion that benefits Republicans."

Your analysis stating Digby is throwing something in Hillary's face based on this post is indicative of the guess that some of Hillary's supporters are her biggest problem. You have added a corollary to it. Just become some people really are out to get her doesn't mean you are not paranoid.